Massage

Clinical reasoning (CR) in massage therapy is the process by which a massage therapist, while interacting with a client, formulates meaning, goals, and treatment strategies based on client preferences, client history, and physical assessment, which are in turn informed by the depth and scope of the massage therapist’s knowledge(1–3) and clinical experience(4,5). Clinical reasoning is not a separate skill acquired independently of medical knowledge; instead, it suggests a continuum on the developmental spectrum of clinical mastery, in which the acquisition of knowledge and the development of clinical reasoning skills occur concurrently(2).

Clinical reasoning can be further understood by looking at four key components that constitute the CR of massage therapy practice:

The overarching philosophies of a massage therapist regarding models of health and mechanisms of pain govern all of that therapist’s clinical decisions(3,6). These philosophies dictate the scope of CR and provide the lens through which the therapist views all other pieces of clinical information.

Hypotheses provide a tentative explanation for the presenting complaints of a massage client. The hypotheses are based on a massage therapist’s understanding of anatomy, physiology, kinesiology, and pathology(7), and can be tested by further investigation. They are modified when new information becomes available.

Assessment and treatment techniques may be chosen by a massage therapist for a variety of reasons, including established protocols for specific modalities, successful outcomes in treating similar conditions, and client preferences(5,8).

Clinical expertise can be developed only through experience(9), as a massage therapist develops professional judgment(3), technical proficiency(7), and pattern recognition ability(3,5,10–12) over time.

In the field of massage therapy, CR is a relatively under-researched topic. Researchers from other branches of manual therapy (for example, physical therapy) have been studying CR within their professions for some time(6,9,13,14,16,17). One of the methods employed by these researchers is case reports. By design, case reports integrate the thought process of the therapist into the methodology of the report, so that the reader not only knows what was done, but why it was done. By structuring case reports that focus on the “why,” previously tacit thought processes can become accessible to analysis(18,19).

The present report provides an example of how case reports can be used to study CR in the field of massage therapy. By examining four key components of the CR process, a rationale for the hypotheses that were generated and the choices that were made regarding assessment and treatment can be demonstrated. Through reflective inquiry, the present report describes how one massage therapist used a hypothetico-deductive reasoning strategy and pattern recognition(5,10,20) to influence outcome in a difficult-to-diagnose case of low back pain.